Provider Demographics
NPI:1912229840
Name:MOULTON, JAYME LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:JAYME
Middle Name:LYNN
Last Name:MOULTON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:JAYME
Other - Middle Name:LYNN
Other - Last Name:CLAYTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:2305 COMMERCE BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUND
Mailing Address - State:MN
Mailing Address - Zip Code:55364-1493
Mailing Address - Country:US
Mailing Address - Phone:952-471-2560
Mailing Address - Fax:
Practice Address - Street 1:2305 COMMERCE BLVD
Practice Address - Street 2:
Practice Address - City:MOUND
Practice Address - State:MN
Practice Address - Zip Code:55364-1493
Practice Address - Country:US
Practice Address - Phone:952-471-2560
Practice Address - Fax:952-471-2465
Is Sole Proprietor?:No
Enumeration Date:2010-02-19
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5307111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor